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Ohio's Medicaid Program > Providers > ODJFS Trading Partners

EDI Trading Partner Information Guide
The Information Guide serves as the first point of reference for all trading partners. Please use it with any of the Companion Guides listed below. Please check this Web page for updates to the Information Guide and all other materials listed below.

Companion Guides
The following guides are HIPAA compliant and are part of the ODJFS EDI Program. 

  1. 837 Health Care Claim Institutional
  2. 837 Health Care Claim Professional
  3. 837 Health Care Claim Dental
  4. 835 Health Care Claim Payment Advice
  5. 270 Eligibility, Coverage or Benefit Inquiry
  6. 271 Eligibility, Coverage or Benefit Information
  7. 276 Health Care Claim Status Request
  8. 277 Health Care Claim Status Notification
  9. 820 Premium Payment
  10. 834 Monthly Member Roster
  11. 278 Health Care Services Review Information - Request
  12. 278 Health Care Services Review Information - Response

Other Required Transactions:

  1. TA1 Transmission Acknowledgement
  2. 824 Application Advice
  3. 277 Unsolicited Health Care Claim Status Notification
  4. 997 Functional Acknowledgement
     

ODJFS includes legacy EOB codes on the outbound 835.  These codes are used for the testing environment only, not in production.

  1. 835 Testing Addenda

NCPDP
For all NCPDP-formatted claims (including Medicare crossovers and TPL claims), the provider needs to submit the claim via Pharmacy Point of Sale (POS) connection to ACS State Healthcare  More information can be found at the Medicaid-Point-of-Sale Claims Processing site.

HIPAA Compliant Codes
Crosswalk from Medicaid Local Codes to HIPAA Compliant Codes and Modifiers for Specificed Providers for Physcians, APNS, Clinics, Limited Practitioners, Excluding Injection and DME Codes - A guide to providers to indicate what the new HIPAA Compliant codes will be when local level codes are discontinued.  In the documents, the effective date for each of the new codes is specifically indicated.  Please see the rule number that is indicated for each code for more detail.

Change Journal for Companion Guides


Ohio EDI